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SITE EVALUATIONANWOR SEPTIC PERMITAPPLICATIO~ILD~lq~ ~SP~0bl
<br />1, Location of In~ :alia:ion fi~,~, o~-e, ?YO~-
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<br />Contractor Information
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<br />Property Owner Maihng Address; Phone No.
<br />Auth. AgentdL,easee Mgililag Address: ~hoRe No,
<br />Courior ~ugi~g Name ~Num~ ' ......... '
<br />DEQ ~ceu~ed Coatr~l~ & No. M~liag Ad.ss: Phoa~ No.
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<br />Commercial (1)SF-Dail~ Sewage Flow) ] '
<br />Site Evalualion~ first 1000 gal. DSF ...... $ 200.0( 5g20,00] $
<br />Site Evaluation, ea. addL 500 ~al, DsF.,,, 60,00 20,00/n
<br />Construction & RePair P~rmlts
<br />Standard Sy~tem less than 100~.,.g0,1, DSF 200.00 10,00
<br />Stand~rd System mo~¢ than 1000 gal, DSF:
<br />$200:00 + $15/each addl. 500 gal, DSF 10,00
<br />Capping Fill 330,0( 10,00
<br />D[sposa! Tren¢.12e~,in Saprolite 200,0( 10.00
<br />Gray Water Waste Disp,o.,.~, ~ump 95,0( 10.00
<br />. !~91diag Tank ..... 200.0( 10.00
<br />Pressure Distribubon 280.0( 10.00
<br />Redundant $~stem .... 200.0( 10.00
<br />Sand Filter 355,0( 10,00
<br />.... Seepage Tren~b' , .... ' ...... 200,0~ 10.00
<br />Steep Slope 200.0C I0,00
<br />'Iil~ Dewat~rlng System ...... 2gO.,O~ 10.00
<br />Plan Review
<br />600~L DSR 10Ol ~al. DSF .... ~0.0~ .00
<br />.... (~xcept SAND FILTERS)
<br />For ~cb aadidonal,,,~oo ~, D~F 20.00 " '"
<br />Altexafiona 200,00 10.00
<br />Repai~.Minor 60.00 10,00
<br />Coastmefion P~rrnit Renewal (Field X/~it~)' 120.00 10,00
<br />Construction Pea,mit Renewal (No Field Visits) 70.00 10.00 .....
<br />Existin~ System Evaluatlon Report 120,00 IO,00
<br />Authorization Notie~ (Fie.!fl yi,si0 ..... 120.0~
<br />Authosiza,.fi,ga Notice (No Field Visit) .... 70.00 IOJX)
<br />Annual Evaluation ~,Altornafivc Syst~ra 120,00 10,00
<br />Annual,?aluationofLargeSystem, 7.5.00 lO,00
<br />Pumper Track Inspectioa, First track 50.00 ,00
<br />Pumper Truck Inpse~on ea. nddl. track ........ 35,00 ,00
<br />Other
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<br />(Mark ~f Applicable to fibs Application) ) %st Hole,~ are Dug
<br /> ) I will call when Test Flole~ Dug
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<br />) 1 ara perfotllfing work on a prol~r~y I own or occupy
<br />) I am a rvgistercd builder or ( ) the atahofizexl rcprezenmtlve
<br /> of a registered bdildor,
<br />) 'l~e work will be performed by a DEQ Licensed Installer
<br />) Other '
<br />) I agree to inmall according to the subn~tted pla~s and
<br /> spe~ifications~ die laws o£ the Sta~e of Ocegon and the
<br /> ordinanee~ of Marion County.
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<br />MC 15-74 REV 1/92
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<br />Residential Singl~ Family =_
<br />Site EvaluatiOn, first lot ............. $ 200,00 $20.0~ $
<br />$1te Evaluation, es, nddl,,,!9~ .... 165,00 20,0~
<br />....Cgnslruofion permit
<br />Standard System 200,00 10,0~
<br />Capping Fill 330,00 10,00
<br />Gray Water Dispos~!.~.m, p ........... 95.00 I0.00
<br />, ,Holding Tank 200.00 10.00
<br />Redundant ........200,00 10.00
<br />Tile I~,w. 5E~ag ,280,00 10,00
<br />Repair, Majo~ (dralnfield) ....... 95,GO 10.00
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<br />....P.?pair, Minor (rank) ...... $0.0o 1o;oo
<br />Constraction Permit Renewal (Field,,yislt) 120.00 10.00
<br />Construction Permit Renewal
<br /> 'ReinFection Fee 25,00 .00
<br /> AuthorizationNoiie~"(FieldVisit), , 120.00 10.00
<br /> E xisting S~te'xn Evaluati,~,~ 120,00 10,00
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<br />ReCeipt No. I ~/a~ O
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<br />NA~E OF APPLICANT~ (please print):
<br />SIGNATURE OF APPLICANT:
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<br />DATE:
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